title: Estimated kidney function based on serum cystatin C and risk of subsequent coronary artery calcium in young and middle-aged adults with preserved kidney function: results from the CARDIA study.
abstract: Whether kidney dysfunction is associated with coronary artery calcium (CAC) in young and middle-aged adults who have a cystatin C-derived estimated glomerular filtration rate (eGFRcys) greater than 60 mL/min/1.73 m(2) is unknown. In the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (recruited in 1985 and 1986 in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California), we examined 1) the association of eGFRcys at years 10 and 15 and detectable CAC over the subsequent 5 years and 2) the association of change in eGFRcys and subsequent CAC, comparing those with stable eGFRcys to those whose eGFRcys increased (>3% annually over 5 years), declined moderately (3%-5%), or declined rapidly (>5%). Generalized estimating equation Poisson models were used, with adjustment for age, sex, race, educational level, income, family history of coronary artery disease, diabetes, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and tobacco use. Among 3,070 participants (mean age 35.6 (standard deviation, 4.1) years and mean eGFRcys 106.7 (standard deviation, 18.5) mL/min/1.73 m(2)), 529 had detectable CAC. Baseline eGFRcys was not associated with CAC. Moderate eGFRcys decline was associated with a 33% greater relative risk of subsequent CAC (95% confidence interval: 5, 68; P = 0.02), whereas rapid decline was associated with a 51% higher relative risk (95% confidence interval: 10, 208; P = 0.01) in adjusted models. In conclusion, among young and middle-aged adults with eGFRcys greater than 60 mL/min/1.73 m(2), annual decline in eGFRcys is an independent risk factor for subsequent CAC.
authors.affiliation: Division of Nephrology, University of California, San Francisco, 521 Parnassus Avenue, Box 0532, San Francisco, CA 94143, USA. nisha.bansal@gmail.com
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Michael
authors.initials: M
authors.lastname: Steffes
authors.forename: John Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000032:analysis*; D015331:Cohort Studies; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D002118:Calcium
keywords: calcification; cardiovascular diseases; chronic kidney insufficiency; coronary arteries; coronary disease; cystatin C; glomerular filtration rate; kidney